Head computed tomography (CT) examinations are used in acute settings to exclude structural pathology for patients with various psychiatric presentations.1 Recommendations for neuroimaging in psychiatric illness vary and mostly address first episodes of psychosis.2 To our knowledge, no current guidelines address specific and common psychiatric presentations such as hallucinations, delusions, and suicidal ideation. This study aimed (1) to determine the yield of head CT examinations for actionable pathology in common psychiatric presentations and (2) to characterize any very low–risk scenarios in which imaging may be avoidable.